IV start in Assisted Living Facility

Specialties Geriatric

Published

I work in a small assisted living facility (6 residents). There are 3 CNA's and the administrator. The administrator was a CNA years ago doesn't have her certification anymore.

Here is my question: She told me the other day that we can start IV's there at the facility if we had someone who needed one. I know that neither I nor the other CNA's have EVER had ANY kind of training in starting IV's and I'm fairly sure the administrator hasn't either.

I just don't see how what she told me can be true and I'm pretty sure it isn't. In the hospitals around here, IV's are started only by RN's. What are your thoughts?

Up Vote Up Vote ×
Specializes in MED/SURG STROKE UNIT, LTC SUPER., IMU.

If I am reading your post correctly, you are a CNA? If that is the case you CAN NOT start IVs. Only nurses can start them, either an RN or a LPN who has IV certification. DO NOT! DO NOT! do anything outside of your scope of practice or training. It will be your butt on the line.:nono:

Up Vote Up Vote ×

Believe me, I wasn't planning on starting any IVs. I was very curious and doubtful about a lot of things the administrator says, this is only one of them.

Up Vote Up Vote ×

What might be available to you through your pharmacy is a service where an IV nurse is sent to start the IV for you guys....since you cannot hang meds I am not sure what good it will be.

Do any of you even know how to start an IV? Was she drunk?

Up Vote Up Vote ×
What might be available to you through your pharmacy is a service where an IV nurse is sent to start the IV for you guys....since you cannot hang meds I am not sure what good it will be.

Do any of you even know how to start an IV? Was she drunk?

Nope, none of us know how to start an IV. I seriously doubt the admin does either. She is.... interesting. She leads people to believe she is a nurse and acts like she is a doctor.

Really, though, since we are assisted living, it would seem like a patient requiring an IV would also require more care than we can provide in most cases...

Up Vote Up Vote ×
Specializes in multispecialty ICU, SICU including CV.
If I am reading your post correctly, you are a CNA? If that is the case you CAN NOT start IVs. Only nurses can start them, either an RN or a LPN who has IV certification. DO NOT! DO NOT! do anything outside of your scope of practice or training. It will be your butt on the line.:nono:

THIS IS COMPLETELY INCORRECT. You do not need a nursing license to start an IV. EMTs start IVs on the back of ambulances. In the hospital, many non-licensed staff with the phlebotomy/IV team start IVs. In EDs, many techs start IVs. You do need to be trained, however -- generally you have to prove competency and that documentation goes in your employee file.

Now, giving meds IV -- that does require a license. I guess my big question with this posting is why on earth would you need to start an IV in an assisted living facility (especially if it is staffed by CNAs only, who can't give meds)? My understanding is that most of them are very minimal care (ADLs, pill setup, maybe SQ insulin). I would think that if someone needed IV therapy, they either need to transfer to a higher level of care (at least a NH/TCU) or have a home infusion service brought in.

Up Vote Up Vote ×
Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.

In the state where I work, there are a NUMBER of requirements mandated by the state that must be fulfilled before IV therapy can be instituted in a health care facility. Protocols have to be in place! There must be a licensed person on staff who is certified in IV management (at least that is how it is in the state where I work).

If the individual warrants IV therapy, it sounds like he/she needs to be moved to a facility that can provide a higher level of care. Yes, the assisted living facility is the person's home, and many, many individuals receive IV therapy in their homes, but the therapy is managed by an MD and home care nurses.

IV therapy has inherent risks; do not risk your livelihood because the administrator says "it's OK." NO judge in a court of law would say "it's OK" when a person has incurred serious injury d/t lack of appropriate/necessary care associated with IV therapy management!

Up Vote Up Vote ×
THIS IS COMPLETELY INCORRECT. You do not need a nursing license to start an IV. EMTs start IVs on the back of ambulances. In the hospital, many non-licensed staff with the phlebotomy/IV team start IVs. In EDs, many techs start IVs.

Now, giving meds IV -- that does require a license. I guess my big question with this posting is why on earth would you need to start an IV in an assisted living facility? My understanding is that most of them are very minimal care (ADLs, pill setup, maybe SQ insulin). I would think that if someone needed IV therapy, they either need to transfer to a higher level of care (at least a NH/TCU) or have a home infusion service brought in.

That is what I'm thinking too. I can't (right now) remember how the IV conversation came up but I distinctly remember her saying that we could start IV's there. And I also remember thinking that she must have lost her mind.

Up Vote Up Vote ×
Specializes in Developmental Disabilites,.

She is way off base. With no training you can not start IVs and as others have said even if you could there is no point in starting one as only an RN or higher can give IV meds. IVs can cause serious injuries and should not be attempted by an untrained person.

Up Vote Up Vote ×
Specializes in MED/SURG STROKE UNIT, LTC SUPER., IMU.
THIS IS COMPLETELY INCORRECT. You do not need a nursing license to start an IV. EMTs start IVs on the back of ambulances. In the hospital, many non-licensed staff with the phlebotomy/IV team start IVs. In EDs, many techs start IVs. You do need to be trained, however -- generally you have to prove competency and that documentation goes in your employee file.

Now, giving meds IV -- that does require a license. I guess my big question with this posting is why on earth would you need to start an IV in an assisted living facility (especially if it is staffed by CNAs only, who can't give meds)? My understanding is that most of them are very minimal care (ADLs, pill setup, maybe SQ insulin). I would think that if someone needed IV therapy, they either need to transfer to a higher level of care (at least a NH/TCU) or have a home infusion service brought in.

I was thinking in a clinical setting. Good point! I was not considering EMTs when I wrote this. I should have said with the correct training, not "only a nurse". The point is, if there is no training on IVs, certification, or someone who could even hang the meds, then this should not be done and I was advising the OP not to do anything outside of her scope of practice. It does sound like the administrator is very....interesting to say the least.

Up Vote Up Vote ×
Specializes in Trauma, Cardiac.

I've worked as the RN for an ALF. I always called in a home health IV agency to start the IVs, due to the liability, and the fact that there was enough work to do already. I instructed the caregivers (usually CNAs) in how to do personal care around an IV site - beyond that, they weren't allowed to touch them. The IV therapies were usually short term, for hydration, or for IV antibiotics managed by the agency nurses. If the resident is really sick and unstable, they should be in a hospital, or have a hospice agency involved if they're needing terminal care. The administrator will always object to hospitalization, even if it's best for your resident, because the resident doesn't pay rent while they're admitted. The admin will want to do IV therapy, because in most ALF companies, they can then charge more for the RN in-house to monitor it, because the level of care has gone up. For the admins, it's ALL about income. The families should be told these things, but sometimes aren't. Your resident will get safer care in the hospital - maybe fewer personal touches from kind caregivers like yourself, but at least safe care.

Even if your state allowed CNAs to start IVs, you're not being paid enough for that kind of liability. We're all better off sticking to what we do often, and do well.

And beware of administrators in assisted living, or LTC, that used to be CNAs or even LPNs. These folks think that since they've had some management training, they know everything that RNs know. They are "wannabe" nurses who quite likely were not good CNAs - otherwise they'd still be involved in nursing. They are being paid good money, as long as they bring in income for the facility. Admins. who were never nurses tend to know their limits. Steer clear of this woman until she does something to embarrass or anger the owners. You could also report her anonymously for her statement about IVs, to the state board of nursing, and they would make a random drop-in visit to check on things.

Good luck to you! Keep up the good work.:nurse:

Up Vote Up Vote ×
I've worked as the RN for an ALF. I always called in a home health IV agency to start the IVs, due to the liability, and the fact that there was enough work to do already. I instructed the caregivers (usually CNAs) in how to do personal care around an IV site - beyond that, they weren't allowed to touch them. The IV therapies were usually short term, for hydration, or for IV antibiotics managed by the agency nurses. If the resident is really sick and unstable, they should be in a hospital, or have a hospice agency involved if they're needing terminal care. The administrator will always object to hospitalization, even if it's best for your resident, because the resident doesn't pay rent while they're admitted. The admin will want to do IV therapy, because in most ALF companies, they can then charge more for the RN in-house to monitor it, because the level of care has gone up. For the admins, it's ALL about income. The families should be told these things, but sometimes aren't. Your resident will get safer care in the hospital - maybe fewer personal touches from kind caregivers like yourself, but at least safe care.

Even if your state allowed CNAs to start IVs, you're not being paid enough for that kind of liability. We're all better off sticking to what we do often, and do well.

And beware of administrators in assisted living, or LTC, that used to be CNAs or even LPNs. These folks think that since they've had some management training, they know everything that RNs know. They are "wannabe" nurses who quite likely were not good CNAs - otherwise they'd still be involved in nursing. They are being paid good money, as long as they bring in income for the facility. Admins. who were never nurses tend to know their limits. Steer clear of this woman until she does something to embarrass or anger the owners. You could also report her anonymously for her statement about IVs, to the state board of nursing, and they would make a random drop-in visit to check on things.

Good luck to you! Keep up the good work.:nurse:

O.....M.....G That statement right there describes her PERFECTLY! You would not believe all the things she thinks she is an expert on when in truth, she has no idea what she is talking about. For example, her "knowledge" concerning diabetes is alarming. She obviously knows nothing at all about the disease. She has a lot of the old beliefs about DM e.g. table sugar is the only thing that matters, never considering carbs. My knowledge is so much more extensive than hers but I learned quickly not to argue with her. Let her believe what she wants and mind my own business is the best approach.

No, I would NEVER do anything like start an IV. Ever. Not until I'm a nurse, anyway... I'm a nursing student so there is no way I would anything to screw that up!

Up Vote Up Vote ×
+ Add a Comment